Differential Diagnosis
The patient presents with lower pelvic pain, irregular menses, and a history of tubal ligation. The pain is described as sharp, pressure-like, and intermittent, radiating to the anus, and is exacerbated by physical activity. The patient also reports changes in bowel movements and a separate complaint of right breast pressure.
- Single most likely diagnosis
- Ovarian cyst: The patient's symptoms of pelvic pressure, irregular menses, and sharp pain radiating to the anus are consistent with an ovarian cyst. The fact that the pain is exacerbated by physical activity and has a sudden onset also supports this diagnosis.
- Other Likely diagnoses
- Endometriosis: The patient's history of pelvic pain, irregular menses, and bowel movement changes are consistent with endometriosis. The fact that the pain is sharp and radiates to the anus also supports this diagnosis.
- Constipation or bowel obstruction: The patient's report of changes in bowel movements and soft, brown stools could indicate constipation or a bowel obstruction, which could be causing the pelvic pain.
- Uterine fibroids: The patient's symptoms of pelvic pressure and irregular menses could be consistent with uterine fibroids, although the sharp pain and radiation to the anus are less typical.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ectopic pregnancy: Although the patient had her tubes tied, there is still a small risk of ectopic pregnancy, which can be life-threatening if not diagnosed promptly.
- Ovarian torsion: Sudden, severe pelvic pain can be a sign of ovarian torsion, which requires emergency surgery to prevent ovarian necrosis.
- Appendicitis: Although the patient denies abdominal pain, appendicitis can present with pelvic pain and changes in bowel movements, and is a medical emergency if not diagnosed promptly.
- Rare diagnoses
- Adenomyosis: The patient's symptoms of pelvic pressure and irregular menses could be consistent with adenomyosis, although this diagnosis is less common and would require further evaluation to confirm.
- Pelvic inflammatory disease (PID): The patient's symptoms of pelvic pain and irregular menses could be consistent with PID, although this diagnosis is less likely given the patient's history of tubal ligation and lack of other symptoms such as fever or discharge.